Words mean things

Have you ever referred to someone you are working with as a “client,” “patient,” or as a “case number”? Have you ever thought of the people you work with in terms of their diagnosis, medical needs, or crimes? Although this may be easier for us to say or a quick way to refer to the people we work with, have you ever thought about how this impacts how you work with or view people? In looking at the impact of our words on ourselves, our practice in child welfare, and the families we serve, we created a training program called Words Mean Things.

The conception of Words Mean Things began two years ago after we read Drs. Lori Ashcraft and William A. Anthony's “Tools for transforming language” article in the April 2006 issue of Behavioral Healthcare (https://behavioral.net/ashcraft0406). Drs. Ashcraft and Anthony point out the impact that our language has on the people we work with and support, as well as on our service outcomes. They suggest that how we write about the families we work with impacts how we think about them, which ultimately directly affects our ability to fully support them and see them as people just like us.

Our child welfare director saw the importance of this article, and we were given the task of putting together a curriculum to train employees on this topic. The hope was that by beginning to address the way we use language, we could begin to look at the way we serve our families, and try to help them have a better experience working with our agency. In our work in child welfare, we can use language that desensitizes us to what a family is experiencing or makes situations appear “further away” from us. This is not our intention, but rather an unfortunate by-product of using words or phrases over and over again without being mindful of their impact.

This is not about being politically correct; this is about being strength-based in the language we use in documentation for or about families, such as court reports, as well as in the way we speak to and about the families we work with. We want families to hear and experience what they did well, not just what brought them to our attention. Changing our language, or at least being open to how we use language, is the beginning step in this process.

We want child welfare workers to realize how language influences their beliefs about themselves and others, and to parlay that into written documentation. The other areas we hope to improve by examining our language are legal accountability, our professionalism through our written work, and families' outcomes, as well as addressing fairness and equity and thus decreasing the impact of bias.

We began to research what else had been done in this area and if there were training programs that addressed the use of language in child welfare services. There is practically no research on the topic, but we did find the University of California, Berkeley's CalSWEC Common Core Curriculum in Framework and Case Planning for Child Welfare Workers useful. We began to compile information and, as a part of the training development process, presented the information to our Cultural Competency Oversight Committee (CCOC), which views language competency and its impact on family outcomes as a cultural issue as well as a practical application we can use in our services.

The four-hour Words Mean Things training begins with introductions and background on how the training was created. To start the discussion about language and casework, we introduce a controversial quote about how we often view families' strengths and weaknesses (see quote by Michael Durrant at https://www.cyc-net.org/today2000/today000703.html). Next, “parent partners” provide the trainees with the family perspective on case plans and court reports, indicating the impact of our words and documentation on their lives. Our parent partners were at one point involved with the child welfare system, with their children residing in foster care due to abuse or neglect. These parents were so successful following through with their case plans to regain custody that they now are mentors for other parents struggling with similar issues. Their involvement in Words Mean Things has been powerful, as they discuss the impact of our words on them, how they interpreted what we said, and how we can change the words we use to have the most impact.

The training then focuses on strength-based language. Recognizing that some words provide separation and disempowerment, the material gives examples of common social work terms and then offers more strength-based and factual alternatives. The training's final segment gives actual examples of strength-based documentation, as well as more dramatic and derogatory examples that don't give enough information to the family or the court. This allows staff to realize that we all have been guilty of using language that may be demeaning, noninclusive, and quick to judge. We also discuss the impact that drama has on our language to make a case in the courtroom. Words Mean Things emphasizes that all staff needs to do is state the situation in an honest and factual way without incorporating words that produce drama and negativity to sway the judge/attorney's opinions or to make our case. Words Mean Things ends with trainees dividing into groups to write the story of a family through concise, factual, strength-based documentation.

To examine whether there were changes in staff's self-report of their understanding and perceived ability to use these skills, a pretest and post-test were conducted. A within subjects paired t-test analysis found a statistically significant positive change for eight of the nine questions (in terms of increasing cultural competency). Question seven (I am able to view the families I work with as people not as diagnoses, cases, or clients), the only question without a significant change, also had the highest initial mean score (4.42 out of a possible score of 5), which suggests that there may have been a “ceiling effect” on this question. The ceiling effect refers to when the initial (in this case pre-test) data in a paired comparison are so high (e.g., near the ceiling or maximum score) that there is little or no room for the following scores (in this case post-test) to increase. 

Contra Costa County's Employment & Human Services Department has mandated Words Mean Things for its Child Welfare and Workforce Bureaus. In our bureaus alone, we estimate that we have trained 600 people. We have provided the training in other counties and have been asked to do so in other states. We would like to take this opportunity to thank Drs. Ashcraft and Anthony for bringing this important topic to our attention and, unbeknownst to them, lighting the spark that created a well-received and important training component in Contra Costa County.

Amy Rogers, MFT, ATR-BC, is a Staff Development Specialist for Employment & Human Services in Contra Costa County, California.
Joan Miller, MSW, is a Child Welfare Supervisor in Children & Family Services, a Bureau of Employment & Human Services in Contra Costa County.

For more information, e-mail arogers@ehsd.cccounty.us or millejd@ehsd.cccounty.us.

Behavioral Healthcare 2008 December;28(12):32-33